DESCRIPTION: Our broad, long term objective continues to be the development of technologies for precisely measuring optic nerve and retinal changes that will enable early detection of glaucoma and of glaucoma progression. This translational research project is a collaborative effort of our multidisciplinary team of ophthalmologists, engineers, computer scientists and physicists at the University of Pittsburgh, Tufts University School of Medicine, Massachusetts Institute of Technology and Carnegie Mellon University. Our Specific Aims are (1) To detect the earliest possible evidence of glaucomatous damage and progression through objective, quantitative structural and functional assessment. We will compare ocular structural measurements (OCT, CSLO, SLP) and ocular function measurements (perimetry and multifocal visual evoked potential) using the historical and prospective examinations on the subgroups in our long-term longitudinal Boston cohort and new longitudinal prospective examinations on our Pittsburgh cohort. We expect that changes detected with structural measures will precede those detected with functional techniques. (2) To determine whether a synergistic index of correspondence, that combines structural and perimetric data, accelerates the ability to detect perimetric abnormality or progression in glaucoma. This prospective experiment will evaluate the ability of combined structural and functional correspondence indices to reliably predict visual field results in early to moderate glaucoma patients. Such an index could reduce or eliminate the need for confirmatory perimetric testing in the future and (3) To advance micron-scale tomographic imaging using OCT measurement technology for early detection of glaucoma and for more sensitive discrimination of progression. A new, high speed, high resolution instrument that we have developed provides about 1-3 mu m axial resolution at 16,000 axial scans per second. We will evaluate in healthy, suspect and glaucomatous subjects the ability of this and other technologic strategies that we are developing - including, tracking-OCT and spectral-domain-OCT - to provide even better image registration, measurement reproducibility and discriminating power. This project addresses the Strategic Research Priorities stated in the National Plan for Vision Research, to ".. .develop improved diagnostic measures to detect optic nerve disease onset, progression, and treatment effectiveness."